Đặc điểm kỹ thuật, giá trị phát hiện hạch và hạch di căn của indocyanine green trong phẫu thuật nội soi cắt dạ dày vét hạch D2 điều trị ung thư biểu mô tuyến dạ dày

Abstract

Objective: To evaluate the technical characteristics and diagnostic value of Indocyanine Green (ICG) for detecting lymph nodes and metastatic lymph nodes during laparoscopic gastrectomy with D2 lymphadenectomy in the treatment of gastric adenocarcinoma. Subject and method: A prospective descriptive study was conducted at the 108 Military Central Hospital from August 2021 to December 2024. Patients received submucosal ICG injection endoscopically one day prior to surgery. During surgery, a fluorescence imaging system was used to guide D2 lymphadenectomy. Result: A total of 81 patients were enrolled, with an average age of 61.7 ± 9.9 years and an average BMI of 22.13 ± 2.86kg/m². Preoperative staging primarily included cT2-3 (98.8%). The mean duration between ICG injection and surgery was 21.4 ± 2.9 hours. Technical success of ICG injection was achieved in 75.3% of cases, with minor complications including one case of subserosal hematoma, ICG diffusion over the gastric wall in 6 cases (7.4%), and diffuse staining around lymph nodes in 16 cases (19.8%). The average number of lymph nodes harvested per patient was 37.8 ± 11.8, of which fluorescent nodes averaged 30.2 ± 11.1. The node detection rate of ICG was 79.9%, notably with 90.9% of metastatic nodes showing fluorescence. Among non-fluorescent nodes, 97.1% were negative for metastasis. Conclusion: The technique of submucosal injection of ICG around the tumor one day before surgery can visualize the peritumoral lymphatic system, enhancing the efficiency of lymph node dissection during laparoscopic radical gastrectomy.